Past papers 2 Flashcards
Requirements of section 10 exemption in aseptics
NOTES Technical Learning Outcomes
Section 10 exempts a pharmacist from needing a license in certain circumstances:
-Under supervision of pharmacist and in accordance with a doctors prescription
-Preparation uses closed systems
-Licensed sterile ingredients (or manufactured in licensed facilities)
-Exp 1 week (supported by stability data)
-All activities done in accordance with NHS guidelines
What is COSHH
Control of substances hazardous to health
Put in order of biggest to smallest
QA QC GMP
Biggest QA (process oriented) GMP QC (product oriented) Smallest
NICE renal function levels
AND
ACR
G1 >90 G2 60–89 G3a 45–59 G3b 30–44 G4 15–29 G5 <15 Kidney failure
ACR NICE renal function levels and what is the point in them?
Prognostic (proteinurea)
A1 <3
A2 3-30
A3 >30 Severely increased
First line antiemetics in PD
Domperidone (PO or PR)
Ondansetron (PO/IV)
Cyclizine is also fine
Antiemetics contraindicated in PD
Prochlorperazine and metoclopramide
HbA1c levels indicating diabetes
48
42-47 is high risk
random BMs that would indicate diabetes
11
or for fasting >7mmol/L
When does NICE offer statins to diabetes pt
and which statin
10 year risk >20%
Atorva 20
For T1DM which long acting is preferred
Detemir BD
alternatively OD glargine or OD detemir
When would you consider metformin in T1DM
BMI > 25
South African and related ethnicity
Want to use less insulin
Wait how long after amending insulin to make another change
3-4 days
BP targets in diabetes (2)
130/80 with target organ damage
140/90 otherwise
BP meds in diabetes 1 and 2nd line
- ACE
2. ACE + CCB/diuretic
what is first line, rate or rhythm in AF
Rate
EXCEPT:
Offer rate control as the first‑line strategy to people with atrial fibrillation, except in people:
-whose atrial fibrillation has a reversible cause
-who have heart failure thought to be primarily caused by atrial fibrillation
-with new‑onset atrial fibrillation
-with atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm
-for whom a rhythm control strategy would be more suitable based on clinical judgement
What do we use for pharmacological cardioversion
Flacanade (if no damage) or amiodarone (if structural damage)
Anticoagulation times to consider during cardioversion
Anticoagulate for 3 weeks before and 2 weeks after
(if onset is less than 48hours then you don’t need to anticoagulate and can just cardiovert. If its longer cardioversion will cause clots to explode everywhere out of the heart and cause a stroke)
RATE CONTROL
what is first line??
second?
FIRST
Beta blocker
2nd
CCB OR if in HF/sedentary digoxin
What would you do in a patient with AF who had an intercerabral haemhorrage
hold DOAC for 4-6 weeks depending on bleed risk
Restart DOAC (not warfarin as this has a higher risk of incercerebral haemorrhage)
Compare bleeding risks of DOACs and Warfarin
DOACs - more GI bleeds
Warfarin - more intercranial bleeds (which are more dangerous than GI bleeds)
Pill in the pocket -> how long would it take for AF to resolve
6-8 hours. If doesnt resolve in 24 hours go to a&e. Don’t take more than one dose in 24 hours.
Inform doctors when taken
Studys that show DOACs are as good as warfarin
How long was warfarin required to be in therapeutic range?
ROCKET AF - rivaroxaban
ARISTOTLE - apixaban
(RE-LY - dabigatran)
70% of time warfarin was in therapeutic range
AVERROES trial showed
Apixaban is better than aspirin in preventing stroke in AF
